What is Hernia?

A hernia is an outpouching of viscera beyond its anatomical confines. It’s most common in the abdomen, but can also occur in the groin, navel, and umbilicus. The most common abdominal wall hernia is the inguinal hernia. In this type of hernia, both males and females are susceptible although males have a higher predisposition.  The risk factors for hernia include modifiable and non-modifiable.

Modifiable risk factors include:

  • Obesity
  • Lifestyle include heavy weight lifting
  • Smoking leading to chronic cough
  • Chronic constipation
  • Straining from urinary difficulties 

Non-modifiable risk factors include:

  • Age
  • Male gender
  • Being white
  • Previous surgery for hernia

There are several types of hernia:

  • Inguinal hernia – This is the most common type of hernia, occurring when part of the intestine pushes through a weak spot in the lower abdomen near the groin area.
  • Femoral hernia – This type of hernia occurs when part of the intestine pushes through a weak spot in the upper abdomen near the groin area.
  • Ventral hernia – This type of hernia occurs when part of the intestine pushes through a weak spot in the abdomen wall.
  • Incisional hernia – This is a type of hernia that occurs after a surgical incision.
  • Hiatal hernia – This type of hernia occurs when part of the stomach pushes through an opening in the diaphragm.
  • Umbilical hernia – This type of hernia occurs when part of the intestine pushes through a weak spot in the abdominal wall near the umbilicus (belly button).

What are the Symptoms of Hernia?

When it comes to hernia symptoms, it’s important to understand that not all hernias cause symptoms. However, some of the common symptoms associated with hernias include a visible lump or bulge that appears during certain activities or in certain physical positions and goes back in at other times. 

You may also feel pressure, a dull ache or pinching when the hernia comes out. It may come out when you’re straining, lifting, laughing or coughing. In the case of an abdominal hernia, you may experience nausea and/or vomiting, loss of appetite, and decreased bowel movements. 

You may also feel a pulling sensation in the affected area. Additionally, some people may experience pain and discomfort when they’re trying to pass gas or strain to use the bathroom. A hernia can also cause abdominal tenderness and a feeling of fullness in the abdomen. 

If a hernia becomes incarcerated, it may become difficult or impossible to push the hernia back into the abdomen. Additionally, if the hernia is strangulated, it can cut off the blood supply to the hernia, leading to serious complications. If you suspect that you may have a hernia, it’s important to seek medical attention as soon as possible. 

Your doctor can diagnose a hernia based on a physical exam and imaging tests, such as an ultrasound or CT scan. Depending on the type and severity of the hernia, your doctor may recommend surgery as a treatment option.

No matter what type of hernia you have, it’s important to be aware of the common symptoms. If you experience any of the symptoms associated with a hernia, it’s important to seek medical attention right away.

What are the Possible Complications of Hernia?

When it comes to hernias, complications can vary depending on the type of hernia and the degree to which it is impacting your life. A hernia occurs when an organ or tissue pushes through a weak spot or hole in the muscle or connective tissue that holds it in place. Hernias can develop in different areas of the body, such as the abdomen, groin, or even the diaphragm.

The most common complication of a hernia is incarceration, which is when the hernia gets stuck and can’t move back in. This can be incredibly painful, and if the hernia is in the bowel, it can cause an obstruction that prevents food or gas from passing through. If the hernia is incarcerated and doesn’t have access to blood supply, this can lead to tissue death, or necrosis or gangrene.

Diaphragmatic hernias, on the other hand, typically don’t lead to complications, except for hiatal hernias, which can cause chronic acid reflux. Congenital diaphragmatic hernias (CDH) are more complicated because they impact the way the fetal organs develop. Babies born with CDH are critically ill and require intensive care.

Overall, hernias can range from minor to serious, so it’s important to be aware of the possible complications and seek medical help if you’re experiencing any signs or symptoms of a hernia. Your doctor can help you determine the type of hernia you have and provide the best treatment plan and follow-up care. With the right care, many hernias can be managed without any major complications.

How is Hernia Diagnosed?

Diagnosis of a hernia can be a simple process, depending on the type of hernia you have. In most cases, your healthcare provider can diagnose a hernia with a simple physical exam. Through the physical exam, they will be able to identify any lumps or bulges in your abdomen and groin area, which may be an indication of a hernia. 

If your healthcare provider can see or feel the hernia, they may be able to determine its severity by attempting to reduce it — which is to attempt to make the hernia go back inside the body. In some cases, a hernia may be too small or deep for your healthcare provider to feel or see it during a physical examination. 

If this is the case, they may order a soft tissue imaging such as a CT scan. A CT scan is a type of imaging test that uses X-rays to create detailed pictures of the inside of your body. With this test, your healthcare provider will be able to identify the size, severity, and location of the hernia. 

If you are experiencing pain or discomfort in the abdominal area or groin, it is best to speak to your healthcare provider to determine if it is caused by a hernia. They will be able to provide you with a diagnosis and any necessary treatment. 

It is important to note that hernias can be dangerous if left untreated, so it is important to get it looked at as soon as possible. If you think you may have a hernia, make sure to schedule an appointment with your healthcare provider.

What are the Treatment Options for Hernia?

Conservative Measures for Hernia Management

The modifiable risk factors should be mitigated to prevent any worsening of the hernia. In addition, wearing a hernia truss helps to minimize discomfort and reduces the chance of complications by keeping the hernia reduced.

The complications for hernia include intestinal blockage or obstruction, strangulation or intestinal perforation. Most hernia patients are asymptomatic or only having mild discomfort at the initial stage. 

It is advisable to see a physician early for a consultation on the necessity for surgery. Although the risk of complications is low, the risk of the surgery also increases with advancing age and increasing hernia size. Hence, a balanced approach should be adopted for the need for hernia surgery.

Open Hernia Mesh Repair

An incision is made on the affected side and the hernia contents are reduced. With the excess sac removed, the normal anatomy is restored with the use of a mesh to encourage healing of the weak part of the abdominal wall. Mesh repair is the standard of care as the lack of tension in such repairs results in a significant decrease in the risk of recurrence.

Laparoscopic Hernia Mesh Repair

Which include TEP, TAPP and IPOM Laparoscopic hernia repair and their various techniques are employed for different situations. The most performed approach would be the totally extra-peritoneal approach (TEP). In general, the laparoscopic approach has benefits of being able to repair hernias from both sides at the same time and minimizing the post-operative pain.

What Happens if Hernia is Left Untreated?

When a hernia is left untreated, the opening in the abdominal wall can continue to stretch and weaken, allowing more tissue to push through. This can lead to the hernia becoming “incarcerated,” which means that the tissue is stuck in the hernia and can no longer be pushed back in. 

If a hernia becomes incarcerated, it can lead to a strangulated hernia. In this case, the hernia has completely blocked the blood supply to the tissue, leading to tissue death and the potential for infection. This type of hernia is considered a medical emergency and can require surgery to repair.

In addition to being painful, an incarcerated hernia can lead to other complications such as obstruction or perforation of the intestine. This can cause nausea, vomiting, and abdominal pain. If a hernia is left untreated for too long, the intestines can become twisted, resulting in a life-threatening condition called an intestinal volvulus.

In summary, hernias are a common problem, but if left untreated, they can become much more severe. If you suspect you have a hernia, it’s important to seek medical attention right away. Treatment options vary depending on the size and type of hernia, but early diagnosis and treatment are essential to avoid complications.

Frequently Asked Questions

  • Can hernia fully heal?

    Hernia being an anatomical disruption, cannot heal by itself. It either remains the same or worsens over time. That being said, some types of hernia don’t have to be corrected surgically like hiatal hernia. The reason is that hiatal hernias are generally asymptomatic and medications are effective in controlling the symptoms associated with it. 

    Hence although medications and lifestyle modifications do not heal hernia but can bring about improvement in symptoms for some times of hernia and thus avoiding the need for surgery.

  • What can cause hernia to worsen?

    Essentially, the modifiable risk factors for hernia can be mitigated to avoid the worsening of hernia. The common pathophysiology for worsening of hernia is related to any increase in intra-abdominal pressure. 

    So the avoidance of straining, heavy weight lifting, chronic constipation and problems in passing urine will allow a decrease in duration of time of elevated abdominal pressure. Smoking itself has multiple effects on hernia. Firstly, it can lead to collagen damage and thus weaken the abdominal wall. 

    Secondly, it can cause chronic cough from irritation of the throat or chronic obstructive pulmonary disease. Lastly, it also increases risk of cancer and predisposes patients to poor healing which results in a higher risk for incisional hernias after surgery.

  • What is the most serious type of hernia?

    All hernias can result in serious complications as mentioned in the above section. Amongst the possible complications, the worst type is strangulation of the bowel resulting in the need for an emergency surgery and resection of unhealthy bowel. 

    This surgery is often high risk and carries a significant risk of morbidity and mortality. Thus it is important to treat hernias early and be counseled for the elective operative risk versus the chance of strangulation. 

  • Will sitting make hernias worse?

    Essentially sitting although increases the abdominal pressure, but does not significantly worsen most types of hernia. In a rare type of hernia called epigastric hernia, sitting up from lying down can worsen the symptoms. In such cases, an abdominal wall truss is prescribed to help alleviate the symptoms when sitting up.

  • How do I know if I need hernia surgery?

    It is important to consult a surgeon to understand the pros and cons of surgery for hernia. Most hernias do require surgery with hiatal hernia and umbilical hernia being the exceptions. 

    That being said, sometimes it is better not to operate especially if the hernia is asymptomatic and the patient has significant risk factors for surgery like diminished cardiovascular function or poor respiratory reserves. 

    If the patient has multiple previous surgery, repair of the hernia can also be difficult and carries a significant risk of recurrence. Thus the benefit of hernia surgery, like any other surgery, has to be balanced with the risk of the surgery.

  • Is hernia surgery painful?

    The pain from the wounds after a hernia surgery are usually very well tolerated. Laparoscopic repair for ventral hernias will require the use of abdominal tacks for the meshes and these can result in increased pain after the surgery. Although the pain can be significant, most are alleviated by the use of postoperative analgesia. 

    If you experience severe pain after a hernia operation, it is important to consult the primary surgeon. Severe pain after a hernia operation could imply a complication and early detection and treatment is important.

  • Will life be normal after a hernia surgery?

    Most patients will be advised to avoid strenuous exercise and heavy lifting for at least 6 weeks after operation. For patients with incisional hernias, or significant loss of abdominal wall domains, this advice may be stretched till beyond 6 months. The rest of the activities should be back to normal once the wound has healed. 

    If there are any predispositions to the hernia like constipation, then lifestyle modifications would have to be instituted to minimize the risk of recurrence. Smoking would have to be stopped after surgery.

  • Is hernia surgery a permanent fix?

    The recurrence of hernia after inguinal hernia repair surgery is estimated to be about 1-2 %. It is uncommon but recurrences are usually harder to manage as the mesh from the previous operation can result in intense fibrosis from the scarring. A recurrence hernia will need to be counseled for the risk of staged repair in the event that bowel resection is carried out or the use of special types of mesh to prevent future recurrence.